颅内动脉瘤支架结合弹簧圈栓塞术后不同双联抗血小板治疗维持时间对迟发性脑缺血的影响  

Effect of Different Maintenance Time of Dual Antiplatelet Therapy After Intracranial Aneurysm Stent and Coils Embolization on Delayed Cerebral Ischemia

作　　者：马可[1] 廖晓 吕华东[1] 苏胜有 MA Ke;LIAO Xiao;LU Huadong(Qinzhou First People's Hospital, Guangxi Qinzhou 535000, China)

机构地区：[1]广西壮族自治区钦州市第一人民医院神经内科,广西钦州535000

出　　处：《河北医学》2021年第6期995-998,共4页Hebei Medicine

基　　金：广西省科学研究与技术开发计划课题,(编号:20185003)。

摘　　要：目的:研究颅内动脉瘤支架结合弹簧圈栓塞术后不同双联抗血小板治疗维持时间对迟发性脑缺血的不同影响。方法:选取回顾性分析方法,研究对象为2017年1月至2019年1月入院的208例颅内动脉瘤患者,所有患者均行支架结合弹簧圈栓塞术治疗,参考术后双联抗血小板治疗维持时间分为三组,即短期组(治疗维持时间3个月,n=63)、中期组(治疗维持时间6个月,n=87)及长期组(治疗维持时间9个月及9个月以上,n=58);观察三组迟发性脑缺血累积发生率,三组迟发性脑缺血累积发生率选取Kaplan-Meier方法统计,组间比较选取Log-rank法;迟发性脑缺血独立影响因素选取Cox比例回归模型进行分析。结果:208例颅内动脉瘤患者中,11例发生迟发性脑缺血,其中短期组5例,中期组6例;短期、中期组较长期组迟发性脑缺血累积发生率更高,差异均有显著性(P<0.05)。单因素Cox分析显示迟发性脑缺血危险因素主要有双联抗血小板持续时间、Raymond分级、瘤颈宽>4mm,糖尿病史、年龄(P<0.05)。多因素Cox分析显示迟发性脑缺血独立危险因素主要有双联抗血小板持续时间、Raymond分级(P<0.05)。结论:颅内动脉瘤患者经支架结合弹簧圈栓塞术后不同双联抗血小板治疗维持时间为9个月及9个月以上可有效减少迟发性脑缺血发生率,颅内动脉瘤患者发生迟发性脑缺血的几率随Raymond分级升高而增加。Objective:To study the different effects of different maintenance time of dual antiplatelet therapy on delayed cerebral ischemia after intracranial aneurysm stent combined with coils embolization.Methods:A retrospective analysis was conducted towards 208 hospitalized patients with intracranial aneurysms,who had stent combined with spring coil embolization between January 2017 and January 2019.Patients were divided into 3 groups,namely the short-term group(maintenance time 3 months,and n=63),medium-term group(maintenance time 6 months,and n=87)and the long term group(maintenance time more than nine months,n=58).The cumulative incidence of delayed cerebral ischemia in the three groups was observed.Kaplan-Meier method was used to calculate the cumulative incidence of delayed cerebral ischemia in the three groups,and Log-rank method was used for comparison between the three groups.Cox proportional regression model was used to analyze the independent influencing factors of delayed cerebral ischemia.Results:Among the 208 patients with intracranial aneurysm,11 cases of delayed cerebral ischemia occurred,including 5 cases in the short-term group and 6 cases in the medium-term group.The cumulative incidence of delayed cerebral ischemia was higher in the short-term and medium-term groups than in the long-term group,and the differences were significant(P<0.05).Univariate Cox analysis showed that the main risk factors of delayed cerebral ischemia were dual antiplatelet duration,Raymond grade,tumor neck width>4mm,history of diabetes and age(P<0.05).Multivariate Cox analysis showed that the independent risk factors of delayed cerebral ischemia were mainly dual antiplatelet duration and Raymond grade(P<0.05).Conclusion:In patients with intracranial aneurysms,the maintenance time of different dual antiplatelet therapy after stent combined with coil embolization is 9 months or more,which can effectively reduce the incidence of delayed cerebral ischemia.The incidence of delayed cerebral ischemia in patients with intracranial aneur

关 键 词：抗血小板 支架 弹簧圈 颅内动脉瘤 迟发性脑缺血 

分 类 号：R74[医药卫生—神经病学与精神病学]